'No cheap, easy or quick fix': Hospitals oust unvaccinated workers in preview of 50-state mandate

Ken Alltucker
USA TODAY

New York this week gave the nation an early glimpse of what the Biden administration's 50-state vaccine mandate for health care workers might look like.

The Empire State's hospitals dismissed or suspended dozens of workers for failing to meet a Monday deadline requiring workers get at least their first dose of the COVID-19 vaccine.

Anticipating service disruptions from frontline health workers quitting or getting fired, health systems from New York City to upstate delayed non-emergency operations, cut clinic hours and paid travel nurses up to $200 an hour to fill vacant shifts.

The dismissals represented a small percentage of workers at large health systems. Most holdout employees got vaccinated in the days leading up to Monday’s deadline as Gov. Kathy Hochul touted a 92% immunization rate among hospital staff this week. 

"I’m not going to sugarcoat it – it’s certainly been difficult," said Bea Grause, president of the Healthcare Association of New York State.

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Despite the short-term headaches, Grause said the mandate is critical "to put COVID-19 in the rearview mirror" and protect workers, patients and the communities they serve. 

“There’s no cheap, easy or quick fix to it, and we’re just going to have to problem solve as we move forward,” she said. 

'More and more jobs open'

President Joe Biden last month announced all hospitals that take Medicare and Medicaid reimbursement must vaccinate their workers. The agency that oversees those federal health programs has yet to announce details on when a national mandate will take effect.

While health leaders acknowledge and support mandatory vaccination, some worry workforce disruptions punctuate a widespread shortage of health care workers at hospitals and clinics nationwide. The number of health job openings swelled during the pandemic with the Bureau of Labor Statistics reporting 1.8 million health care openings as of July, up from 1.1 million open jobs in July 2020. 

Staffing agencies that provide nurses and other temporary health care workers said requests from hospitals have surged during the pandemic. And once the Biden mandate kicks in for hospitals, requests for contract nurses are likely to go higher to fill vacancies amid a nationwide labor shortage.

New York hospitals have achieved a high vaccination rates and hospitals and health facilities have plenty of current and retired health pros to draw from. Perhaps the bigger disruptions will come in smaller communities with lower vaccination rates, said Todd Walrath, CEO of ShiftMed, which places nursing assistants, licensed practical nurses and registered nurses with hospitals and nursing homes.

"We continue to see an erosion of available workers, and more and more jobs open," Walrath said.

Nevertheless, states are pushing ahead with mandates. 

Large California hospitals reported vaccination rates above 90% for a mandate that took effect Thursday for hospital and other health care workers. Two other states, Maine and Connecticut, delayed deadlines to give hospitals and workers more time to comply. Maine's vaccination deadline for health care workers was pushed back a month to Oct. 29. Connecticut's state hospital and nursing home employees must get vaccinated by Oct. 4, a week later than the state's original deadline.

Private health systems are pursing their own mandates, even in states that don't have a broader mandate for health care workers. North Carolina-based Novant Health last week suspended 375 unvaccinated workers and gave them five days to comply with its mandate. Nearly 200 were vaccinated and the remaining employees were dismissed or quit.

About 99% of the health system’s 35,000 employees across 800 locations agreed to get vaccinated.

Carl Armato, president and CEO of Novant Health, said in a statement the health system has added travel workers throughout the pandemic to plug coverage gaps. In the last week, the health system hired more than 150 health workers.

“Without a vaccine mandate for team members, we faced the strong possibility of having a third of our staff unable to work due to contracting, or exposure to, COVID-19,” Armato said in a statement.  “This possibility only increases heading into a fall season with the more contagious and deadly delta variant.”

People gather at City Hall to protest vaccine mandates on August 09, 2021, in New York City.

Rural hospitals brace for mandate

Other experts agree that vaccine mandates are necessary. Not only must hospitals ensure workers are healthy, they must set an example for patients and families, said Dr. Kenneth Campbell, an assistant professor in the Tulane School of Public Health and Tropical Medicine.

As a former operations analyst for the Cook County Health & Hospitals System, Campbell helped implement the Chicago-based health system's policy requiring employees get flu shots. The vast majority complied. A small number of objectors were suspended. 

Hospital executives are accustomed to worker shortages caused by strikes, retirements or chronic staffing gaps. And even though more workers might quit or be dismissed for refusing COVID vaccination, Campbell said it's a necessary tradeoff.

"If we don’t make this stand now, we can lose this war," said Campbell. "Thousands and thousands more lives can be lost." 

Rural hospitals faced chronic doctor and nurses shortages before the pandemic began, and things worsened over the past 18 months, said Alan Morgan, CEO of National Rural Health Association.

Rural communities have higher rates of unvaccinated people, and COVID death rates are higher that metro areas. Unlike large urban hospitals that can recruit staff from big cities and suburbs, rural hospitals don't have the labor pool or financial resources to tap in times of crisis.

Morgan is concerned the federal government hasn't articulated a plan to address inevitable staffing gaps at rural hospitals. The Biden administration could reassure rural hospitals if it released a plan that included steps such as deploying public health service workers and Federal Emergency Management Agency teams, providing funding for hospitals to hire travel nurses or sharing information about available federal grants, Morgan said. 

Morgan cited New York Gov. Hochul's plan to make National Guard troops available to plug staffing gaps at as the "the type of leadership we need" to assist rural hospitals.

"There are a lot of tools available," Morgan said. "But to date, there’s been no indication there's any plan, other than the administration saying we don’t anticipate a problem."

Ken Alltucker is on Twitter as @kalltucker or can be emailed at alltuck@usatoday.com.